U.S. patent application number 12/229653 was filed with the patent office on 2010-03-04 for tibia-talus-calcaneus (t-t-c) locking plate.
Invention is credited to William H. Simon.
Application Number | 20100057133 12/229653 |
Document ID | / |
Family ID | 41726506 |
Filed Date | 2010-03-04 |
United States Patent
Application |
20100057133 |
Kind Code |
A1 |
Simon; William H. |
March 4, 2010 |
Tibia-talus-calcaneus (T-T-C) locking plate
Abstract
Disclosed is a bone fusion or implant, method and system for
arthrodesis of a human ankle fusing the distal end of a tibia,
talus and/or a calcaneus bone by employing a single anatomically
lateral incision to the tibia, fibula, talus and calcaneus region,
removing some or all of a fibula in the incision area and attaching
the implant to the tibia, talus and/or calcaneus in a generally
central area of the ankle. The removed portion of the fibula is
morsilized and made into a paste and mixed with an autologous
platelet concentrate that is applied as a bone graft to the implant
site thereby enhancing the arthrodesis site and enhancing
hemostasis.
Inventors: |
Simon; William H.; (Virginia
Beach, VA) |
Correspondence
Address: |
GUERRY LEONARD GRUNE
784 S VILLIER CT.
VIRGINIA BEACH
VA
23452
US
|
Family ID: |
41726506 |
Appl. No.: |
12/229653 |
Filed: |
August 26, 2008 |
Current U.S.
Class: |
606/280 ;
606/286; 606/301 |
Current CPC
Class: |
A61B 17/8057 20130101;
A61B 17/8061 20130101; A61B 17/8085 20130101 |
Class at
Publication: |
606/280 ;
606/286; 606/301 |
International
Class: |
A61B 17/70 20060101
A61B017/70; A61B 17/04 20060101 A61B017/04 |
Claims
1. An implant for inserting into a human ankle for arthrodesis of
the distal end of a tibia, a talus and/or a calcaneus comprising; a
locking-plate and screw fixation device with a thirty degree bend
posteriorly on a distal end of said implant wherein the angle is in
the range of fifteen to forty five degrees.
2. The implant of claim 1, wherein said implant is biocompatible
material comprising titanium, stainless steel or other said
biocompatible material and formable to the contour, shape and size
of said tibia, said talus and said calcaneus.
3. The implant of claim 1, wherein said implant comprises holes at
various locations along said implant and said holes are provided at
various angles to said longitudinal surface and said distal end and
wherein said holes optionally include interior threads.
4. The implant of claim 3, wherein said holes at various angles
guide said fasteners for specific location within said tibia, said
talus and/or said calcaneus such that said fasteners are
overlapping, parallel, divergent or convergent and said fasteners
optionally comprise exterior threads that mate with said interior
threads of said holes to secure said fasteners to said implant.
5. The implant of claim 1, wherein said lateral incision to said
ankle provides ease of access to said ankle region of said tibia,
fibula, said talus and said calcaneus.
6. The implant of claim 1, wherein a portion of said fibula is
removed and morsilized or pulverized to form a paste, powder or
slurry that may be mixed with an autologous platelet concentrate to
form a bone graft.
7. The implant of claim 6, wherein a portion of said removed fibula
from the distal end is twelve to fourteen centimeters in
length.
8. The implant of claim 1, wherein said fastener is a rod, screw,
pin, and/or nail.
9. The implant of claim 1, wherein said implant is in a generally
central location and is laterally placed where there is adequate
soft tissue coverage.
10. The implant of claim 1, wherein said implant is utilized for
the arthrodesis of severe ankle and subtalar arthrosis, talar
collapse, avascular necrosis, hindfoot deformity, stage 4 flatfoot
and/or Charcot deformity.
11. The implant of claim 1, wherein said lateral incision to said
ankle provides ease of access to said ankle region whereby said
implant and/or said bone graft may be inserted directly laterally
into an anteriolateral and/or posteriolaterial position.
12. An implant for inserting into a human ankle for arthrodesis of
the distal end of a tibia, a talus and/or a calcaneus comprising;
employing a single anatomically lateral incision to an ankle region
of said tibia, fibula, said talus and said calcaneus, removing some
or all of said fibula in said ankle region, attaching said implant
with fasteners to said tibia, said talus and/or said calcaneus in a
generally central location within said ankle region thereby fusing
said tibia, said calcaneus and/or said talus together stabilizing
said ankle, making a paste derived of any or all of removed said
fibula, applying said paste of said fibula as a bone graft to said
implant, said tibia, said talus and/or said calcaneus, thereby
enhancing the ability to achieve arthrodesis and hemostasis.
13. A method for inserting into a human ankle for arthrodesis of
the distal end of a tibia, a talus and/or a calcaneus comprising;
placing a patient on the operating room table in the supine
position, performing an extensive anatomically lateral incision
over the fibula exposing the distal end twelve (12) to fourteen
(14) centimeters of the fibula surgically removing and cleaning all
soft tissue, morsilizing and mixing with autologous platelet
concentrates thereby forming bone graft providing additional
healing in the arthrodesis site, debriding the T-T-C, T-T or T-C
joint surfaces of all articular cartilage so raw bone is exposed
for the arthrodesis such that if the talus exhibits avascular
necrosis or is destroyed, a tibial-calcaneal arthrodesis can be
performed either without an interpositional graft or with an
interpositional graft such as a with a femoral head in order to
maintain length of the extremity, placing the foot in alignment
with the second metatarsal aligned with the tibial crest and the
ankle at zero degrees of dorsiflexon, providing a temporary
Steinman pin placed from the plantar aspect of the heel into the
distal tibia, optionally taking X-rays at this time to-check
alignment, placing cannulated screws from the distal tibial
metaphysis across the arthrodesis sites to obtain compression,
wherein placing at least one cannulated screw from the distal
anterior tibia into the calcaneus posteriorly is accomplished and
wherein placing a second screw from the posterior tibia into the
medial column of the foot is performed under fluoroscopic guidance
and through the single lateral incision site.
14. The method of claim 13, wherein the lateral T-T-C, T-T or T-C
locking plate implant is contoured to the patient's anatomy and
wherein a large fixed angle locking screw is placed first into the
sustentaculum of the calcaneus
15. The method of claim 13, followed by placing polyaxial-screws
for additional fixation into the calcaneus and for additional
compression placing a non-locking screw by eccentric drilling or
applying a compression device to the tibia and applying a plate
allowing the remaining fixed angle locking screws to be inserted
and secured, followed by evaluating and checking screw lengths and
alignment by fluoroscopy.
16. The method of claim 13, wherein using the bone graft harvested
from the fibula and processed to fill in any deficits and placed
posteriorly through the laterial incision for an extra-articular
arthrodesis is performed and wherein tissues are closed in layers
and a drain is properly placed to prevent post operative
hematoma.
17. The method of claim 13, wherein performing removal of the
fibula is performed ensuring there is sufficient soft tissue
coverage of the locking plate.
18. The method of claim 13, wherein placing a post-operative
dressing is accomplished along with a posterior splint and wherein
the drain is left in for 24 to 48 hours.
19. The method of claims 13-18, wherein once the operation is
complete, dressings are changed and the patient is placed into a
non-weight bearing fracture brace until healing has occurred based
upon X-ray analysis and wherein standard healing time is
approximately six to twelve weeks.
Description
FIELD OF DISCLOSURE
[0001] The field of the present invention relates to a method and
device for repairing or fusing damaged, deteriorating, or fractured
tibia, talus and calcaneus bones in the ankle region. More
particularly, the present invention relates to both a method and
device for treating tibia, talus and/or calcaneus bones that are
affected by illness or injury using lateral incision(s) and joint
fusion(s).
BACKGROUND OF DISCLOSURE
[0002] Implants are foreign devices which may be inserted into any
bone. The utilization of implants in the treatment of bone
fractures with plates, screws, intramedullary nails and rods are
well known to those in the art. Various types of implants exist in
the prior art, each composed of different materials and having
different shapes with various degrees of functionality.
[0003] Intramedullary nails are adapted for insertion into the
medullary canal of a bone or bones. Intramedullary nails have been
limited in their application to long or large bones and such use
has been widely known for long or large bones of the upper
extremities (humerus, radius, ulna) and lower extremities (femur,
tibia, fibula). Use of intramedullary nails allows physicians to
secure fractured bones, maintain a desired length, and prohibit
rotary motion while the bone heals and has time to rehabilitate.
Intramedullary nails are also used for the fusion of bones. In an
arthrodesis model the tibia, talus and calcaneus fracture repair
failed at lower loads over time, resulting in cracks or breaks, as
compared to blade. (Chiodo, Christopher P., Acevedo, Jorge I.,
Sammarco, V. James, Parks, Brent G., Boucher, Henry R., Myerson,
Mark S., Schon, Lew C.; "Intramedullary Rod Fixation Compared with
Blade-Plate-and-Screw Fixation for Tibiotalocalcaneal Arthrodesis:
A Biomechanical Investigation"; The Journal of Bone & Joint
Surgery, Vol. 85-A, Number 12, Pgs.2425-2428, December 2003)
[0004] Plates that incorporate a series of holes for screw
insertion are also typical implants for the fixation of bones and
joints. Plates to be used may be linearly straight or may have some
curvatures or undulations, depending on the anatomical location and
bone size. These curvatures or undulations are for placement for
conforming to the bone circumferential shape and/or diameter. The
hole positioning may provide for straight or angular insertion of
the fasteners or screws that are to be used. Fasteners generically
include all attaching means by which an implant may be attached to
or connected with bone.
[0005] Such fasteners are inserted through a fastener hole or slot,
also described as transfixation holes and screw holes. The use of
plate locking screws is optional depending upon the severity of the
bone damage. Static locking, by insertion of screws in proximal and
distal locations, neutralizes rotational stresses while preventing
shortening of the limb.
[0006] Generally, tibiotalocalcaneal fixation with plates requires
either anterior and/or posterior incision and anterior and/or
posterior placement of the respective implant device in relation to
the T-T-C interface. One risk factor involving anterior
implantation is that the implant is placed close to the skin and
therefore there is increased risk of wound dehiscence, and
ultimately, removal of the implant.
[0007] While there is much in the art regarding implants, there is
a need for a lower infection risk implant and method for
arthrodesis of the T-T-C region of a human foot. Such an implant
and procedure may likely have any or all of the similar properties,
features, and characteristics of the above mentioned implant
methodologies, but greatly reduces the risk of wound dehiscence by
providing an implant that is further from the skin surface than the
present anterior implant methodologies.
RELEVANT ART
[0008] U.S. Pat. No. 6,974,461, to Wolter, Dietmar, and unassigned,
describes a fixation system for bones comprising: a force support
having a posterior surface and an anterior surface; at least two
holes in the force support each having an axis; and at least two
bone screws each having a screw head portion and a non-head
portion; wherein the bone screws are adapted to be inserted into
the holes, where at least one hole has at least one deformable
element which can become deformed by turning a bone screw into a
hole, whereby the deformable element fixes a bone screw into a
hole, where the deformable element is one selected from the group
consisting of: a ridge, a lip or and an edge, and where the
deformable element extends in a plane oriented obliquely to the
axis of the hole.
[0009] U.S. Pat. No. 6,322,562, to Wolter, Dietmar, and unassigned,
describes a fixation system for bones comprising: a connection
carrier with at least one passage hole; at least one bone screw
inserted into the at least one passage hole; the connection carrier
including a seat surface and the bone screw including a seat
surface, permitting a mutual alignment at various angles for fixing
the bone screw at a certain angle to the connection carrier, the
bone screw further including a preformed thread below the bone
screw seat surface, the preformed thread deforming a portion of the
passage hole below the seat surface of the connection carrier when
the bone screw is screwed in so that a thread connection is formed
between the bone screw thread and the connection carrier, the
deformation being formed by rotating the bone screw at a certain
angle to the connection carrier.
[0010] U.S. Pat. No. 4,794,918, to Wolter, Dietmar, and unassigned,
describes a bone plate arrangement comprising:a bone plate
including at least one bone screw hole having a center line and a
seat on the upper side of the bone plate opposite the lower side
adapted to face the bone, said seat having an acutely narrowing
profile in the direction from the upper toward the lower side; a
bone screw having a longitudinal axis, said bone screw adapted to
pass through the bone screw hole into the bone and including a bone
screw head having a generally convex seating surface which is
contoured such that when the bone screw is fully inserted into the
bone through the hole with the axis along a selected one of a range
of angular orientations relative to said center line, the seating
surface of the head is supported in said seat; a cover plate
including means for engaging the bone plate so that the underside
of the cover plate tightly engages the screw head; and said bone
screw head and the underside of the cover plate having raises and
recesses which mutually engage when the cover plate tightly engages
the screw head so as to hold the head in fixed lateral relation to
the bone plate and prevent pivoting thereof, whereby the bone screw
axis is fixed in said selected angular orientation relative to the
hole centerline.
[0011] U.S. Pat. No. 4,705,031, to Wolter, Dietmar, and unassigned,
describes an osteosynthesis plate for the pressure stabilization of
bone fragments, comprising; a base plate for spanning the bone
fragments, the base plate having a first end adapted to lie on a
first bone fragment and an opposed second end adapted to be secured
on a second bone fragment; at least one slot in the first end of
the base plate, each slot being elongated in the direction between
said plate ends, each slot having a plurality of screw hole
sections adapted to receive a bone screw, the sections lying
end-to-end on a uniform pitching spacing; each of said screw hole
sections including a ramp sloped downwardly in the direction toward
the second end of the base plate, the ramp having a useful ramp
length defined by the distance the base plate would move relative
to the first bone fragment as a bone screw is advanced into the
bone fragment from an initial position at the top of the ramp to a
final position at the bottom of the ramp; wherein the pitch for the
screw hole sections in a given slot is no greater than the number
of slots in said first end of the plate, multiplied by the useful
ramp length.
[0012] U.S. Patent Publication No. US20070055234A1, to McGrath, et.
al., and unassigned, describes a method of reconfiguring an
external fixator that is stabilizing bone, comprising: selecting a
subject having one or more bones fixed by an external fixator
including a frame having a pair of frame members connected to the
one or more bones and a plurality of struts defining a
substantially fixed relative position of the pair of frame members;
bracing the frame with a brace; reconfiguring the frame while the
brace restricts movement of the pair of frame members; and removing
the brace after the step of reconfiguring such that the external
fixator with the reconfigured frame fixes the one or bones without
the brace.
[0013] PCT Patent Publication No. WO07035713A2 to Kaelblein, et.
al., and assigned to Small Bone Innovations, Inc., describes a
condylar plate for fixation of a small bone fracture comprising two
or more tines and a plate integral with tines and comprising one or
more apertures configured to receive a fastener. The tines of the
condylar plate are configured to be fixed to the condyle portion of
the small bone. Additionally is a method of fitting a condylar
plate to a small bone in a patient, with the method comprising
molding a pliable condylar plate template having a shape that
corresponds to a shape of the condylar plate to the small bone. The
template comprises a longitudinal planar shaft substantially
identical to a longitudinal planar shaft of the condylar plate and
the template comprises apertures in a position substantially
identical to a location of the tines are located in the condylar
plate. Drilling holes through the apertures into the bone to
indicate where the tines of the condylar plate will be fixated to
the bone and bending the condylar plate to conform to the template
configuration.
[0014] PCT Patent Publication No. WO06007965A1 to Wolter, Dietmar,
and unassigned, describes an invention relating to a bone-fixation
system comprising a connecting support that contains several bores
and at least one bone screw that can be inserted into a bore. The
system is characterised in that it comprises at least one filler
element that can be inserted into a bore, in addition to means for
securing the filler element in the bore.
[0015] Russian Patent Publication No. RU2226079C2, to Konjukhov,
et. al., and unassigned, describes an method involves performing
arthrodesis of talonavicular, calcaneocuboid and talocalcanean
joints, separating from attachment place together with cortical
plate of short finger extensors, filling with bone autotransplants
produced when making articulation resection of free interosseous
spaces, stretching anterior tibial muscle tendons, common finger
extensor and short tibial muscle tendons, shortening Achilles
tendon and transplanting long tibial muscle tendon on calcanean
tuber, setting dislocation in the first metatarsophalangeal joint
in open way. The achieved disposition is fixed by means of wires
conducted through calcaneus, talus and distal epiphysis of tibia,
through talus, navicular bone, calcaneus and cuboid bone and the
first finger and the first metatarsal bone.
[0016] Russian Patent Publication No. RU2193366C2, to Dolgopolov,
et. al., and assigned to Rossijskij Nauchno-Isseldovatel'skij
Institut Trav, describes a method involves applying Ilizarov
apparatus over the talocrural articulation area at the first stage.
Distraction is carried out until the lost distance between the
calcaneus and the tibia is recreated. Fibula osteotomy is carried
out at the second stage without taking off the Ilizarov apparatus
and necrotized areas of the talus are removed. So a created defect
is substituted with an iliac bone autograft and fibula
osteosynthesis is carried out.
SUMMARY OF THE DISCLOSURE
[0017] An object of the present disclosure is to provide a bone
fusion or implant device, method and system for inserting an
implant in a human ankle, fusing the distal end of a tibia, the
talus and/or calcaneus bone by employing an anatomically lateral
incision to the tibia, talus, fibula and calcaneus region, removing
some or all of a fibula in the incision area, attaching the implant
to the tibia, talus and/or calcaneus in a generally central area of
the ankle allowing for fusing the bones together, making a
cortical-calcaneus bone graft for any of the bones where such a
graft is useful including a portion of the fibula, applying the
cortical-calcaneus bone graft as a packing of the anterior and
posterior regions to achieve an extra-articular arthrodesis to
assist in fusion. The implant is generally centrally located within
the confines of an ankle region for stabilizing the T-T-C. These
devices and procedure increases the ability to achieve successful
and sustainable arthrodesis.
[0018] Another objective is to attach the implant to the tibia,
talus and/or calcaneus by means of rods, screws, pins, nails or
other means of attachment.
[0019] Another objective of the disclosure is to remove some, or
all of the fibula wherein a portion of the fibula that is removed
may be morsilized into a paste, powder or slurry as a
cortical-calcaneus graft mixed with an autologous platelet
concentrate and packed over the implant as a means prevent wound
dehiscence of the arthrodesis site. The platelets release growth
factors to stimulate bone growth and help reduce hemorraging.
Hemostasis is enhanced with platelet concentration.
[0020] An additional objective is to include an implant device that
is malleable for forming around the contours of the tibia, talus
and/or calcaneus and may be of a length and width to accommodate
bone size and deformity and may be comprised of stainless steel,
titanium or another biocompatible material.
[0021] Additionally the implant is initially formed of a
biocompatible material wherein holes are placed at various
locations along the implant and at various angles to the
longitudinal and latitudinal plane of the implant enabling screws,
rods, pins, nails or other devices securing the implant to the
tibia, talus and/or calcaneus in various configurations including
overlapping, parallel, divergent or convergent within a bone.
[0022] Another objective is to provide placement of the implant
generally centrally within and interiorly separate from the skin to
reduce the risk prominence of device (implant) and to prevent wound
dehiscence.
[0023] Another objective of the disclosure is to provide an implant
whereby the distal end of the implant bends at a thirty-degree
(30.degree.) angle or within a fifteen (15.degree.) to forty-five
(45.degree.) degree angle in a posterior direction for attachment
to the calcaneus.
[0024] Another objective is to provide an implant device in the
form of a locking plate and screw fixation device to the tibia,
talus and/or calcaneus.
[0025] Another objective is to provide an implant for the
arthrodesis of severe ankle and subtalar arthrosis, talar collapse,
avascular necrosis, hindfoot deformity, stage 4 flatfoot and/or
Charcot deformity.
[0026] Another objective is to provide an anatomically laterial
incision site whereby an anteriolateral and/or posteriolaterial
implant or grafting may be inserted directly laterally for the
stabilization of the tibia, talus and/or calcaneus.
BRIEF DESCRIPTION OF THE DRAWINGS
[0027] FIG. 1A is an isometric drawing of the T-T-C implant.
[0028] FIG. 1B is an isometric view of a fastener in this case a
typical orthopedic screw.
[0029] FIG. 2A is a lateral skeletal view of the foot showing the
tibia, fibula, talus and calcaneus as well as the midfoot region
and phalanges.
[0030] FIG. 3 is a lateral skeletal view of the foot showing the
tibia, fibula, talus and calcaneus showing the implant fusing the
tibia, talus and calcaneus.
[0031] FIG. 4 is an anterior view of the tibia, talus and calcaneus
showing the implant and phantom views of the fasteners within the
T-T-C region.
DETAILED DESCRIPTION OF THE DRAWINGS
[0032] FIG. 1A is an isometric view of a T-T-C implant [100]
showing the holes [105] which may have internal threads [110] for a
locking feature [115] that would lock a fastener [120] (Ref. FIG.
1C) to the implant [100]. The holes [105] may be perpendicular to
the longitudinal surface [125] of the implant [100] or may be
angled to provide a fastener direction of various configurations
that are overlapping, parallel, divergent or convergent.
[0033] The implant [100] also has a distal end [130] that is larger
than the longitudinal plane [125] that is angled at, or about,
thirty degrees within a range of fifteen to forty five degrees. The
distal end [130] also contains holes [105] of various
configurations that provide direction for a fastener [120] that are
overlapping, parallel, divergent or convergent.
[0034] The implant [100] is made of a biocompatible material that
would typically be titanium or stainless steel and be malleable to
be shaped to meet the contours and undulations of a patients bone
structures and shapes.
[0035] FIG. 1B is an isometric view of a T-T implant [155] which
has a distal end that is angled at ninety-degrees to the
longitudinal plane [125].
[0036] FIG. 1C is an isometric view of a fastener [120], in this
case a typical orthopedic screw [135]. The screw [135] has a wide
spiral thread [140] for insertion into a bone and a narrow external
thread [145] at the head [150] that secures with the hole internal
threads [110] (Ref. FIG. 1A) of the implant [100] (Ref. FIG.
1A).
[0037] FIG. 2A is a lateral skeletal view of the right foot [200]
showing the distal end of the tibia [205], distal end of the fibula
[210], talus [215] and calcaneus [220] as well as the midfoot
region [225] and phalanges [230].
[0038] FIG. 2B is a lateral skeletal view of the right foot [200]
showing the implant [100] fastened to the tibia [205], talus [215]
and calcaneus [220] using screws [135] to secure the implant [100].
A portion of the fibula [210] is shown removed allowing for access
to the lateral aspect of the tibia [205] as well as the implant
[100] being centrally located within the distal portion of the leg
away from the skin (not shown).
[0039] The portion of the fibula [210] which has been removed is
ground or pulverized to form a cortical-calcaneus bone graft
packing [240] (not shown) that may be mixed with an autologous
platelet concentrate and packed over the fastened implant [100] to
aid in hemostasis. The lateral fastening of the implant [100] acts
to secure, or fuse, the tibia [205], talus [215] and calcaneus
[220] and act as an implant and stabilize the fusion of the
skeletal structure.
[0040] FIG. 2C is a lateral skeletal view of the right foot [200]
showing the implant T-T [155] fastened to the tibia [205] and talus
[215] only.
[0041] An alternative method would be to reshape the implant [100]
to secure the tibia [205] and calcaneus [220] should the talus
[215] be removed.
[0042] FIG. 3 is an anterior view of the tibia [205], talus [215]
and calcaneus [220] showing the implant [100] and phantom views of
potential locations of the fasteners [120] or screws [135] within
the T-T-C region. The fibula [210] is partially removed.
Overview of Surgical Technique for T-T-C (Tibial-Talar-Calcaneal),
T-T (Tibial-Talar) and T-C (Tibial-Calcaneal) Arthrodesis
[0043] In the present disclosure the patient is placed on the
operating room table in the supine (face up) position. As prior
art, the posterior approach to T-T-C arthrodesis requires a prone
position (face down) which is more dangerous for the patient from
an anesthesia perspective. It is also more difficult to align the
patient's lower extremity in the correct position with the patient
face down.
[0044] An extensive anatomically lateral incision is performed over
the fibula exposing the distal twelve (12) to fourteen (14)
centimeters of the fibula. This section of fibula is surgically
removed and cleaned of all soft tissue. The fibula section is then
morsilized and mixed with autologous platelet concentrate to form a
bone graft for additional healing in the arthrodesis site. The
posterior approach requires a second surgical site for harvesting
bone graft frequently from the hip.
[0045] The T-T-C, T-T or T-C joint surfaces are debrided of all
articular cartilage so raw bone is exposed for the arthrodesis. If
the talus exhibits avascular necrosis or is destroyed, a
tibial-calcaneal arthrodesis can be performed either without an
interpositional graft or with an interpositional graft such as a
femoral head in order to maintain length of the extremity.
[0046] The foot is placed in alignment with the second metatarsal
aligned with the tibial crest and the ankle at zero degrees of
dorsiflexon. A temporary Steinman pin is placed from the plantar
aspect of the heel into the distal tibia. X-rays are taken at this
time to check alignment.
[0047] Cannulated screws are placed from the distal tibial
metaphysis across the arthrodesis sites to get compression. One
cannulated screw is placed from the distal anterior tibia into the
calcaneus posteriorly. The second screw is placed from the
posterior tibia into the medial column of the foot. Placement of
these screws are performed under fluoroscopic guidance and through
the single lateral incision site.
[0048] The lateral T-T-C, T-T or T-C locking plate implant is
contoured to the patient's anatomy. A large fixed angle locking
screw is placed first into the sustentaculum of the calcaneus which
is the densest part of the bone. Polyaxial screws are then placed
for additional fixation into the calcaneus. For additional
compression a non-locking screw can be placed by eccentric drilling
or a compression device can be applied to the tibia and plate. The
remaining fixed angle locking screws are inserted and secured.
Fluoroscopic evaluation is performed to check screw lengths and
alignment.
[0049] The bone graft that was harvested from the fibula and
processed is used to fill in any deficits and placed posteriorly
through the lateral incision for an extra-articular arthrodesis.
The tissues are closed in layers and a drain is placed to prevent
post-operative hematoma. Removal the fibula ensures there is
adequate soft tissue coverage of the locking plate. An anterior
approach with a locking plate manufactured by Synthes has very
little soft tissue coverage which can lead to wound dehiscence or
pain from the hardware. A post-operative dressing is placed along
with a posterior splint. The drain is left in for 24 to 48 hours.
Dressings are changed and the patient is placed into a non-weight
bearing fracture brace until healing has occurred on X-ray. Healing
time is approximately six to twelve weeks.
* * * * *